Care Management US RN Data Sr Analyst

Siegen HR Solutions; Manila; On-site; PHP 550,000 - 950,000; Full time

Job summary

A healthcare staffing agency in the Philippines is seeking a Care Management US RN Data Sr Analyst. This role involves collaborating with healthcare providers to promote quality member outcomes, optimizing member benefits, and ensuring effective resource use. Candidates must have a BS Nursing degree, an active US state license, and at least three months of clinical RN experience. This position offers a chance to make a significant impact on member care within a dynamic environment.

Qualifications

• Active US State License holder.
• Minimum of three months of experience as a Registered Nurse in a clinical setting.
• Experience includes holding an active RN license and providing direct patient care.

Responsibilities

• Collaborate with healthcare providers and members.
• Optimize member benefits and promote effective resource use.
• Ensure high quality, cost effective care through assessing medical necessity.

Skills

Collaboration with healthcare providers

Assessing medical necessity

Interpreting medical policy

Education

BS Nursing (BSN) Degree

Job description

About the job Care Management US RN Data Sr Analyst

Overall Purpose:
Responsible to collaborate with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources.

Job Description:

• Responsible in collaborating with healthcare providers and members to promote quality member outcomes, to optimize members’ benefits, and to promote effective use of resources
• Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and may steer members to appropriate providers, programs or community resources
• Work with medical directors in interpreting appropriateness of care

TO QUALIFY:

• BS Nursing (BSN) Degree
• Active US State License holder
• A minimum of three (3) months’ of prior working experience as a Registered Nurse in a clinical setting required:
  • Three months is equivalent to 480 hours of working experience as an RN
  • Working experience as a Registered Nurse means holding an active RN license and providing direct patient care
  • Clinical setting includes inpatient hospital or clinic